Provider Demographics
NPI:1427060987
Name:DELEON, CONRADO (MD)
Entity type:Individual
Prefix:
First Name:CONRADO
Middle Name:
Last Name:DELEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1822
Mailing Address - Country:US
Mailing Address - Phone:509-592-9921
Mailing Address - Fax:509-329-6141
Practice Address - Street 1:403 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1822
Practice Address - Country:US
Practice Address - Phone:509-592-9921
Practice Address - Fax:509-357-4645
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024096208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017094Medicaid
WA319201706Medicare ID - Type Unspecified
WA1017094Medicaid